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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by sheilac on September 30, 2012, at 18:39:04
I thought I had it down with 450mg Trileptal and 75mg Lamictal and 50mg Seroquel for sleep.
Seroquel gives me an awesome nights sleep, but still, as always, makes me irritable in the morning. Since starting Lamictal I can't sleep without it. Not even my old standby, Melatonin or Ambien knocks me out.
75mg of Lamical makes me a little too hyper. Plus I start to get itchy gums, sore throat, etc. with 75 - 100mg of Lamictal. Great antidepressant though.
450mg Trileptal isn't enough to balance out the Seroqel morning bitchness and the hyperness brought on by Lamictal.
So - back to 600mg a day of Trileptal - even if it does make me a little depressed. I will have to work on that somehow.
May need find something else for the depression - but what? I was using 5mg Adderall for depression. It worked for focus, concentration, motivation. Not sure if that is a good idea or not. My old doc didn't have a problem with it. Maybe if I am stable enough that is a possibility.
Really need Seroquel for sleep. I am hoping that a morning dose of 300mg Trileptal will halt the Seroquel hangover/Seroquel run out or just plain Seroquel bitchiness. I've never understood why Seroquel makes me super irritable. Does Seroquel effect a certain chemical in the brain that would make me irritable? Odd.
I totally understand that 450mg of Trilepal is not enough of a mood stabilizer.
I got it now. I need more stabilization. Guess I'm a little hard headed or have been in denile.
Posted by phidippus on September 30, 2012, at 19:23:27
In reply to Not so sure about sweet spot..., posted by sheilac on September 30, 2012, at 18:39:04
I'm glad you're increasing your Trileptal-maybe you can make it to the 900 mg mark.
I used to get irritable on Seroquel too.
Why not try an antidepressant for the depression? Maybe you'd do well on Wellbutrin.
Eric
Posted by jono_in_adelaide on September 30, 2012, at 20:24:56
In reply to Not so sure about sweet spot..., posted by sheilac on September 30, 2012, at 18:39:04
It might pay to try Welbutrin befre Adderal?
Funny, Seroquel gives me a great nights sleep when i need it, with no side effects or hangover..... i guess we're all wired differently
Posted by phillipa on September 30, 2012, at 21:14:11
In reply to Re: Not so sure about sweet spot..., posted by jono_in_adelaide on September 30, 2012, at 20:24:56
One time on seroquel in the hospital benzos also the doc took me off it. I almost passed out in am. Phillipa
Posted by sheilac on October 1, 2012, at 7:58:47
In reply to Re: Not so sure about sweet spot..., posted by phillipa on September 30, 2012, at 21:14:11
Wellbutrin makes me manic. Not sure I want to go there again.
Posted by phidippus on October 1, 2012, at 23:12:24
In reply to Not so sure about sweet spot..., posted by sheilac on September 30, 2012, at 18:39:04
If you are having mouth sores and sore throat you really just need to stop the lamictal and go up a little on your Trileptal.
The soars in your mouth are indicative of SJS, this is a syndrome that causes a rash. If you get the rash, you're skin could start to fall off-indeed you can die from SJS.
Please stop taking the Lamictal.
Eric
Posted by Sheilac on October 2, 2012, at 6:03:49
In reply to Re: Not so sure about sweet spot... » sheilac, posted by phidippus on October 1, 2012, at 23:12:24
Eric, I totally understand about stopping Lamictal. The itchy gums and sore throat are weird. I am taking 600mg Trileptal and feeling so much better - stable finally! Maybe in time I can climb to 900mg. Right now my morning 300mg Trileptal makes me sleepy.
If I stop Lamictal I HAVE to replace it with an antidepressant. Otherwise I get very depressed on Trileptal.
Yesterday I was tired from morning Trileptal so I took 5mg of Adderall, which tore up my stomach and had me running to the bathroom. Not sure Adderall is best route out of depression.
Did I mention that Lamictal makes me crazy hungry? I crave carbs and eat like a nut. Gained 10 lbs since Lamictal. I know it's rare, but it can happen.
I have thought of trying Wellbutrin again - low dose going up slowly. In the past Wellbutrin has made me manic, aggressive, mean.
Love Trileptal stability. Now that I am feeling stable could I tolerate Wellbutrin or will it always make me manic? Or would I just have use Wellbutrin and keep upping Trileptal until I can take both meds?
Can't take SSRIs. Don't want the trouble of MAOIs.
Your opinions
Posted by phidippus on October 2, 2012, at 18:20:28
In reply to Eric or SLS anyone opinion?, posted by Sheilac on October 2, 2012, at 6:03:49
>Not sure Adderall is best route out of depression.
I'm not sure either. Amphetamines are usually added to a drug regimine when an antidepressant is only providing partial relief from depression.
>In the past Wellbutrin has made me manic, >aggressive, mean.
One of Wellbutrin's side effects is agitation, so that could be what you were experiencing.
>will it always make me manic?
Not if you keep your trileptal at a high enough dose that it prevents it.
>Or would I just have use Wellbutrin and keep >upping Trileptal until I can take both meds?
That's the ticket.>Can't take SSRIs.
Why not?
>Don't want the trouble of MAOIs.
You don't need an MAOI.
Have you ever tried a TCA? I'd recommend Clomipramine-it never caused me mania.
Eric
Posted by Sheilac on October 2, 2012, at 19:27:59
In reply to Re: Eric or SLS anyone opinion? » Sheilac, posted by phidippus on October 2, 2012, at 18:20:28
I could try Wellbutrin again.
What about low dose Geodon? Bad idea?
Posted by phidippus on October 2, 2012, at 19:54:35
In reply to What about, posted by Sheilac on October 2, 2012, at 19:27:59
You don't need an antipsychotic right now. Concentrate on antidepressants.
I would recommend:
Mirtazapine
Clomipramine
Amytriptaline
Effexor
PristiqNone of which are SSRIs.
Eric
Posted by SLS on October 2, 2012, at 23:15:05
In reply to Not so sure about sweet spot..., posted by sheilac on September 30, 2012, at 18:39:04
In my estimation, minocycline can act to improve bipolar depression and might act as a replacement for Lamictal. Why don't you just go to 600 mg/day of Trileptal and stay there? Why not go to 50 mg/day of Lamictal and stay there? For you, your sense of depression might really be a reaction to the loss of mania. I don't know this for certain, of course, but I think you should consider it as a possibility. I would also consider taking N-acetylcysteine (NAC). It might promote the effectiveness of minocycline and help prevent the neurotoxicity that your illness is surely producing.
- Scott
Posted by phidippus on October 3, 2012, at 12:01:50
In reply to Re: Not so sure about sweet spot... » sheilac, posted by SLS on October 2, 2012, at 23:15:05
Scott has some good ideas. I, however, do not agree with him on keeping the Lamictal. I think you were having an allergic reaction, what with the mouth sores.
Eric
Posted by SLS on October 3, 2012, at 13:08:29
In reply to Re: Not so sure about sweet spot... » SLS, posted by phidippus on October 3, 2012, at 12:01:50
> Scott has some good ideas. I, however, do not agree with him on keeping the Lamictal. I think you were having an allergic reaction, what with the mouth sores.
That is my fear as well. I had hoped that Sheilac would have had her doctor take a look at the lesions last week. They seemed to be absent at 50 mg/day. I don't know what to think. Certainly, it is better to be safe and discontinue the Lamictal rather than to delay in having a doctor evaluate the status of a rash and allow for a more serious SJS reaction to emerge.
Sheilac,There may be no "sweet spot"
You need to discuss this whole thing with your doctor and allow him to examine your rash and lesions.
It might be a good time to allow your brain to settle down a bit by discontinuing the Lamictal. You could continue with the Trileptal at a dosage of 600 mg/day or higher and see where that leaves you, understanding that you might experience a let-down that feels like depression, but is really an attempt by the brain to seek a new equilibrium. This "rebound depression" resulting form Lamictal discontinuation can last a few days. Also, you might be confusing the absence of hypomania as being depression. Don't be so afraid of depression. You should be afraid of mania. Mania sometimes leads to more severe and treatment resistent depressions. You need to stop the rollercoaster ride of medication changes and the variable mood states that you are causing.
1. See your doctor. Create a treatment plan with your doctor that you will adhere to.
2. Decide whether or not to discontinue Lamictal.
3. Discontinue the Lamictal if necessary and perhaps allow some time to evalutate the resultant combination treatment of Wellbutrin (150 - 300 mg/day) and Trileptal (600 - 900 mg/day). It is possible that you will be okay.
4. If you become manic on the combination, you can discontinue the Wellbutrin or add an antipsychotic.
5. If you do not become manic and are left in a residual depression that continues for a week or more, you may want to add Abiify.
6. To be determined.
Which antidepressants have helped you in the past (including those that made you manic)?
- Scott
Posted by sheilac on October 3, 2012, at 17:30:42
In reply to Re: Not so sure about sweet spot... » phidippus, posted by SLS on October 3, 2012, at 13:08:29
I have stopped the Lamictal and hope that the sore throat/gum problems go away soon.
I was trying to take 600mg of Trileptal a day. The PM dose of 300mg knocks me out and I sleep great - thank goodness. Having issues with morning 300mg. After 2-3 hours I fall back asleep or overdose on coffee and still feel tired.
I was told I have to take it twice a day. Not sure if I should take 150mg at 6:00am and my 2nd dose of 150mg at lunch. I think that may cure the zombie feeling.
So far, obviously, no depression. I see my doc next week and we'll see where I'm at then as far as depression goes.
I'm afraid of going back to Wellbutrin due to the past history of mania on it (like my past history with Lamictal). But, maybe it would cure the Trileptal sleepiness and I wouldn't have mania if I am stable on Trileptal - I don't know.
Not sure if taking 40mg of Geodon is a good idea or not for depression. It worked for depression before, just not stability.
Abilify made me fat and super hungry. Not going back.
I think you're right about not being afraid of the depressions and also the adjustment to no mania. As I've gotten older the highs have gotten too high, which is why I felt soooo much better getting back on Trileptal - Lamictal was making me swing way too high.
So, I'm not sure about what to add at this point for depression.
Also - I'm not sure if my dosing of morning Trileptal is a good idea or not. 450mg just doesn't seem enough. 600mg is much better for me.
This is the end of the thread.
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